Wednesday, July 01, 2009

The Medicare Hatchet Begins

CMS is also proposing to stop making payment for consultation codes, which are typically billed by specialists and are paid at a higher rate than equivalent evaluation and management (E/M) services. Practitioners will use existing E/M service codes when providing these services instead. Resulting savings would be redistributed to increase payments for the existing E/M services.

10 comments:

Anonymous
said...

Didn't the ACC email also state a larger percentage reduction for some procedures? It seemed quite high. And the elimination for consultation was interesting as well. Makes me happy I've stayed in the fed system.CardioNP

Acording to Alfred Bove, MD (President, ACC) in the ACC press release: "Services that have improved countless lives by diagnosing and treating cardiovascular disease are scheduled to have payment cuts in the range of 25 to 42 percent."

shadowfax-

I added the references to the original post. I suspect they are related.

The party is over and if you had any doubt, the recession is placing the last few nails in the coffin.

I read the proposed changes yesterday that are touted to increase primary care services by 6-8% next year. They included eliminating the consultaion codes and making everything E & M. the E & M codes will be raised from the savings from getting rid of consultative codes.

The first thing I thought is how unfair this will be to cognitvie specialties (ID and endocrinology come to mind) since they do not have any fancy procedures to offset lower paying office visit codes. Now their 3 extra years of training will net them nothing more in compensation, and they already seem in short supply. So they will get screwed by this change. I would of thought it would have been better to bundle the consultation in with the procedure, where one is done (I know you love bundling) but allow a higher paying consultaion code when the advice stands alone from some usually more lucrative procedure.

It once again highlights that in order to make money in medicine, you have to be doing some procedure or interpreting some test produced by an expensive machine (the more expensive the machine, the higher the physician pay for results interpretation) as opposed to offering advice and counseling. I guess the old saying talk is cheap is true and it seems to be getting cheaper.

Payments to cardiologists would be trimmed by 11% overall, but certain procedures they perform would see steeper reductions. Alfred Bove, president of the American College of Cardiology, figured that cardiologists would receive 42% less for an echocardiogram and 24% less for a cardiac catheterization.

Radiologists would see an estimated cut of 20% for imaging services using expensive equipment such as MRI and CT scans, said Bibb Allen, chairman of the commission on economics at the American College of Radiology. That would be in addition to the cuts imposed on radiologists under a 2005 law, he said.

The proposal, open for public comment until Aug. 31 and expected to be completed by Nov. 1, comes as the Obama administration seeks to boost the number of primary-care doctors to meet the needs of an aging population and care for the newly insured if legislation to overhaul the nation's health-care system is enacted.

Medicare reimbursements for Flow Cytometric services in our Blood & Marrow Transplatation Department has been cut to $16 total per day, no matter the number or type of panels performed. Most lymphoma/Leukemia pts require several panels at any given time depending on the disease, and $16 does not even cover the cost of the antibodies used in any given panel.

i am not sure this will have the intended effect. if you get rid of consultations, the midlevels can see everything. the 15% delta is a tiny drop in the bucket, i can't believe they are going after that.

i am not sure how many people complaining about the salary of physicians understand that this will only indirectly impact physician incomes. are they upset about the take home pay of private physicians who are running small businesses (as opposed to people who draw salaries which are guaranteed by some larger entity) and just want them to earn less no matter what, regardless of how hard they are working?

if the reimbursement is cut, imo, a more likely effect is that the physicians would not retain as many employees and would cut pay raises for employees. it would take longer to answer the phone, longer to get messages back to patients. or cut back on other nonreimbursed services, like answering services for calls at night and just direct patients to the emergency room for nighttime issues. (note this is not a threat, but a prediction of unintended consequences).

I'm a programmer/consultant, and bill at $150/hr. I'm guessing that's a bit more than you will these days. Time to pick up medical programming? Should be a cinch, and if enough of you Atlases shrug, maybe it'll make an impact?

You've spent how much of your life gathering your expertise, and spending how much on your education? How long will you sit there and let the government rape you?

It's a very Obamaian thought process where he believes that FP's and GP's being paid more to do procedures for a lower rate than specialists are currently paid will amount to large savings.Taking that same thought process, perhaps he can cut a deal for all procedures or just establish DRG's for physician’s services. After all, DRG's were placed on hospital procedures back in the early 1980’s and we all know how much they saved consumers. Just 25 years later and Medicaid and Medicare are broke. So will physicians work for “union pay rates” established for all; or will they just work for rates that are fair and charge their own fees which would be less than their current ones since they wouldn’t have to “deal” with government nor insurance!

About Me

Westby G. Fisher, MD, FACC is a board certified internist, cardiologist, and cardiac electrophysiologist (doctor specializing in heart rhythm disorders) practicing at NorthShore University HealthSystem in Evanston, IL, USA and is a Clinical Associate Professor of Medicine at University of Chicago's Pritzker School of Medicine. He entered the blog-o-sphere in November, 2005.
DISCLAIMER: The opinions expressed in this blog are strictly the those of the author(s) and should not be construed as the opinion(s) or policy(ies) of NorthShore University HealthSystem, nor recommendations for your care or anyone else's. Please seek professional guidance instead.